颈椎病致椎-基底动脉供血不足的影像表现

MR angiography of vertebra-basilar arterial blood-supply deficiency induced by vertebra artery-type's cervical spine disorder

目的 依据临床与影像表现,探讨颈椎病致椎-基底动脉供血不足的机制及防治要点。方法 122例颈椎病患者均经磁共振血管成像(MKA)和常规X线检查,部分病例还经CT扫描检查。分析影像表现与临床经过的关系。结果 122例患者中,颈椎动脉MRA显示正常者106例(86.89％),各种异常者共16例(13.19％),其中,先天性发育不良3例,扭曲纤细6例,单侧缺如1例,畸形1例,硬化性改变2例,以及狭窄3例。约85％(103/122)的病例经保守性治疗后,于2周至2个月期间临床症状明显缓解或消失。结论 虽然颈椎骨质增生与横突孔狭窄可导致颈椎病发生。但是,作者认为临床上较多遇到的、更为重要的病因是颈交感神经受到激惹引起椎动脉痉挛进而诱发本病。临床上最关键的防治措施是防止颈椎失稳。

Objective Based on clinical manifestations and MRA findings of the patients with vertebraartery-type's cervical spine disorder (VACSD), to investigate the generative mechanism of vertebra -basilar arterial blood-supply deficiency(VBABSD) induced by VACSD and to propose the gist of clinical treatment and prevention of the disorder. Methods A hundred and twenty-two patients with VACSD underwent MR angiography and conventional roentgenographic examinations. Partial patients underwent additional CT scans. The correlation between MRA findings and clinical course in all patients were analyzed. Results For the MRA of cervical vertebra artery, 106 patients with normal findings and 16 patients with various abnormal findings those included 3 congenital dyspla-sia, 6 kinking or thinning, 1 unilateral (right) deficit,1 deformity,2 sclerotic changes,and 3 stenosis were found in all patients. Clinically approximate 85% of patients (103/122)were significant improvement or vanish from 2 weeks to 2 months after convervative treatment. Conclusion Although bony proliferation of cervical spine or stenosis of transver-sus processus foramen can induce VACSD but the author consider that the irritation of cervical sympathetic nerve is the most important one of factors in the pathogenesis of VACSD. Treating and preventing gist of the disorder is to enhance the training of cervical muscle and to avoid the unsteadiness of cervical spine.